Résumé
Objective To evaluate the safety and effectiveness of a curved vertebroplasty (CVP) compared with traditional unipedicular approach vertebroplasty (UVP) in treating osteoporotic vertebral compression fractures (OVCF).Methods This was a retrospective case control study on the clinical data of 77 OVCF patients (12 males,65 females;aged 55-86 years,mean 70.8 years) admitted between July 2013 and December 2016.There were 6 injured vertebrae at T1 10,73 at T11 L2,and 12 at L3 5.The patients were divided into CVP group (36 patients,44 vertebrae) and UVP group (41 patients,47 vertebrae) with no significant difference in baseline clinical variables.Intraoperative and postoperative complications including neurovascular injury were recorded.Operation duration,fluoroscopy frequency,volume of cement per level,cement leakage rate per level treated,cement distribution,and refracture rate were compared between the two groups.Preoperative and postoperative visual analog scale (VAS) and Oswestry disability index (ODI) were compared both within the group and between the groups.Results No severe complications related to puncture were observed.No significant difference was observed for operation duration,fluoroscopy frequency,and cement leakage rate per level treated between the two groups (P ＞ 0.05).Compared with UVP group,CVP group had larger volume of cement per level [(5.0 ± 1.4) ml vs.(4.3 ± 1.6) ml],more uniform cement distribution (none vs.10 cases),and lower refracture rate (0 vs.10％) (P ＜ 0.05).The two groups were followed up for 6-49 months (mean,25.9 months).Significant improvements on the VAS and ODI were noted within each group (P ＜0.01),but there was no significant difference between the two groups (P ＞ 0.05).Conclusions Both CVP and UVP are safe and effective treatments for OVCF.Compared with UVP,CVP entails more uniform cement distribution and lower refracture rate.
Résumé
BACKGROUND:Currently, the cement delivery device used in vertebral augmentation vertebral augmentation (vertebroplasty and kyphoplasty) has flat tips that cannot be bent. During surgery, we always choose injection cement by symmetric way to keep the balance of power on the biomechanics of the vertebral body, while the traditional cement delivery tube can only be used in ipsilateral vertebral body. OBJECTIVE:To evaluate the feasibility of curved vertebroplasty device for the treatment of thoracolumbar osteoporotic vertebral compression fractures. METHODS: Sixty patients (72 vertebral bodies) with osteoporotic vertebral compression fractures were enroled, including 8 cases of double-level vertebral fractures and 2 cases of three-level vertebral fractures. Al operations applied curved delivery device in percutaneous vertebroplasty. We recorded operation time, intraoperative blood loss, and X-ray imaging data through prospective self control study. Treatment effect was evaluated with modified Oswestry disability index, Visual Analogue Scale scores and the World Health Organization Quality of Life assessment. The patients were folowed up for 6 months to 2 years. RESULTS AND CONCLUSION: (1) Surgery was performed successfuly on al 60 patients. The average operation time was 27 minutes (20-45 minutes) for 50 cases by unilateral transpedicular approach. (2) The mean amount of bone cement in every single vertebral of al 72 vertebrae was averagely 6.4 mL (4.2-9.5 mL). Bone cement distribution had not been found to be biased one-sided without severe leakage. (3) Visual Analogue Scale score and Oswestry disability index were significantly improved at 1 day after treatment (P 0.05). (4) The ratio of good quality of life in 1 month than postoperatively (87%) and in the last folow-up (92%) was significantly greater compared with the preoperative ratio (27%) (P < 0.05). (5) These findings confirmed that curved vertebroplasty device in unilateral pedicle puncture could ensure bilateral symmetric distribution of bone cement. Al patients are satisfied with treatment. It is proved to be a feasible simple and safe method.